daytime sleepiness / sleepy head data

For several years I have been using a Resmed Airsense 10 and have not had stellar results and still have day time sleepyness most days and mental fog. I was prescribed 12 CmH20 pressure. When i received the machine, it was set to 4-20 CmH20, which I have heard is not an ideal setting since the pressure range will vary too much. I have set it to 11.8 - 15 but I was wondering if someone could make any pressure setting changes based on the sleepy head data provided. If any additional screen shots are needed, please let me know. I would greatly appreciate any feedback!

What does your flow limitation graph look like?

Pugsy,

Here is my flow limitation graph. Also, to mention a few more details about my cpap; I am using a ResMed AirFit F20 mask and the EPR setting is at 2, if that matters at all.

Are you experiencing any nasal congestion at all during the night?

Have you ever tried a higher than 11.8 IPAP?
With EPR at 2 that means EPAP is 9.8 ....ever tried more or less EPR?

Have you ever tried more than 16 max pressure (you said 11.8 to 15 but it is 16) ? If so, what happened?

How's the overall sleep quality? Wake often during the night or sleep solidly for the most part with maybe a couple of remembered awakenings.

Take any medications of any kind? If so, what?

Any other physical or mental health issues going on that might impact either how you feel during the day or sleep quality?

Yes, I do experience some nasal congestion at night, so I typically take allegra before bed. I have been taking this medication nightly for the past 6 months. Last night for the first time, I changed the EPR setting and turned it off, which was a bad idea. Instead of turning it off, I think I will instead change it to a 1 and see how that works out. In the past I have changed the IPAP to a higher pressure and didn't notice much of a change, however, in the past when I have change the max pressure sometimes I notice that I swallow air. I believe I had the pressure at 18 when this happened. As far as sleep quality, I do not notice waking up too much throughout the night. On occasion I will wake up anywhere from 1 to 2 times per night and I will briefly be fully awake. Based on the CPAP data, do you see any noticeable changes that should be made? For any physical or mental health issues, I do not believe I have any that would hinder my sleep quality. Thank you for the quick response!

Some of the ugliness on your flow limitation graph could be from nasal congestion...and that means some of the pressure increases you see corresponding with the increased FL activity could be the machine thinking that the FL activity was from airway issues it wants to kill with more pressure. Unfortunately more pressure won't do a darn thing for nasal congestion FLs.

Having problems with aerophagia at the higher pressures is a good enough reason to limit the max ....plus if the machine is wanting to go higher because of nasal congestion it is a lost cause anyway.

How about answers to my other questions?

The only thing I can think of is maybe try a little more minimum pressure.
Reducing EPR increases the overall average a little but if you can't do without EPR or a reduction then just change the minimum pressure a bit upwards and I don't know that it will resolve your problem or not....but worth trying.
Your report isn't horrible but maybe with a little OA/hyponea event reduction you might feel better/sleep better.
Maybe if the pressure line stabilized a little more you would maybe feel better. No guarantees but some people say they sleep better and feel better when there isn't so much movement with the pressure line. Worth trying.
Like maybe a 1 cm increase in that minimum pressure to 12.8. The machine is up there anyway for a good chunk of the time since the median average is around 13 cm.

Remember one change at a time with any of the settings so you can have a better idea what change brought about what result...if any?